The ocular adnexa

The ocular adnexa - INTRODUCTION

The ocular adnexa include

the:
• Orbits
• Extraocular muscles
• Eyelids
• Lacrimal system
• Optic nerves

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 Orbits

• The orbit is a pyramidal, bony cavity in the facial

skeleton with its base anterior and its apex posterior

• The orbits contain and protect the eyeballs and their

muscles, nerves, and vessels, together with most of
the lacrimal apparatus.
The orbit has four walls and an apex
• superior wall (roof) is
approximately horizontal and is
formed mainly by the orbital part
of the frontal bone, which
separates the orbital cavity from
the anterior cranial fossa. Near
the apex of the orbit, the
superior wall is formed by the
lesser wing of the sphenoid bone
• The lacrimal gland occupies the
fossa for the lacrimal gland
(lacrimal fossa) in the orbital
part of the frontal bone.
• The medial wall is formed
primarily by the ethemoid bone,
along with contributions from the
frontal, lacrimal, and sphenoid
bones; anteriorly,
• the paper-thin medial wall is
indented by a lacrimal fossa for
the lacrimal sac and the proximal
part of the nasolacrimal duct. The
medial walls of the two orbits are
essentially parallel, separated by
the ethmoidal sinuses and the
unpper nasal cavity.
• The inferior wall(floor) is formed
mainly by the maxilla and partly by
the zygomatic and palatine bones;
• • the thin floor is partly separated
from the lateral wall of the orbit by
the inferior orbital fissure.
• • The lateral wall is formed by the
frontal process of the zygomatic
bone and the greater wing of the
sphenoid; the lateral wall is thick,
especially its posterior part, which
separates the orbit from the
middle cranial fossa. The
lateralwalls of the two orbits are
nearly perpendicular to each other.
The apex of the orbit is at the optic canal, in the lesser wing
of the sphenoid just medial to the superior orbital fissure.
 https://www.ophthalmologytraining.com/ocu
lar-anatomy/orbital-anatomy
• The tendinous ring, also known as the annulus
of Zinn, is the common origin of the four rectus
muscles (extraocular muscles). The tendinous
ring straddles the superior orbital fissure and
through it (from superior to inferior) pass:
• superior division of the oculomotor
nerve (CN III)
• nasociliary nerve (a branch of the 
ophthalmic nerve)
• inferior division of the oculomotor
nerve (CN III)
• abducens nerve (CN VI)
• The medial portion of the ring also
encompasses the optic foramen through which
the optic nerveand ophthalmic artery pass.
 The extraocular muscles
• The extraocular muscles are located
within the orbit, but are extrinsic and
separate from the eyeball itself. They act
to control the movements of
the eyeball and the superior eyelid.
• There are seven extraocular muscles
– the levator palpebrae superioris,
superior rectus, inferior rectus, medial
rectus, lateral rectus, inferior oblique and
superior oblique. Functionally, they can
be divided into two groups:
• Responsible for eye movement: Recti and
oblique muscles.
• Responsible for superior eyelid
movement: Levator palpebrae superioris.
 eyelids

• The two lids meet each other at medial and lateral angles(or outer & inner
canthi). The medial canthus is about 2mm higher than the lateral canthus It is
the elliptical space b/w the upper and the lower lid.
• When the eyes are opened, it measures about 10-11mm vertically in the
centre and about 28-30mm horizontallly- PALPEBRAL APERTURE
• When eye is open, the upper lid covers about 1/6th of the cornea & the lower
lid just touches the limbus.
• Each eyelid is divided by a horizontal furrow (sulcus) into an orbital and tarsal
part.
 The lid margin
• It is About 2mm broad and is divided into two parts
by punctum.
• • The medial, lacrimal portion is rounded and devoid
of lashes or glands.
• • The lateral, ciliary portion consist of rounded
anterior border, a sharp posterior border and an
inter-marginal strip.
BLOOD SUPPLY ARTERIES: In humans, the
eyelids are supplied with blood by two arches
on each upper and lower lid. The arches are
formed by anastamoses of the lateral
palpebral arteries and medial palpebral
arteries, branching off from the lacrimal
artery and ophthalmic artery, respectively.
VEINS: • These are arranged in two plexus: a
post-tarsal which drains into ophthalmic
veins and a pre- tarsal opening into
subcutaneous veins. • LYMPHATICS: •
Arranged as post-tarsal and pre-tarsal. Those
from lateral half of the lids drain into
preauricular lymph nodes and those from the
medial half of the eyelids drain into
submandibular lymph nodes.
NERVES OF LIDS
• MOTOR NERVES are facial (which
supplies orbicularis muscle),
oculomotor (which supplies LPS
muscle) and sympathetic fibres
(which supply the muller’s muscle).
• SENSORY NERVE supply is derived
from branches of the trigeminal
nerve.
Orbital part – Forced closure of
eyelids – Thus pull eyebrows
downwards
Palpebral part – Helps in gentle
closure during blinking, sleep, soft
voluntary closure . Branches of 7th
nerve Functions of orb. Oculi.
 STRUCTURE ANTERIOR POSTERIOR

• 1.SKIN: It is elastic having fine

texture and is the thinnest of the
body.
• 2.THE SUBCUTANEOUS AREOLAR
TISSUE: It is very loose and contain
no fat. It is thus readily distended by
oedema or blood.
• 3.The layer of striated muscle:
• It consist of orbicularis muscle
which forms an oval sheet across
the eyelids. It comprises three
portions:-1. The orbital 2. The
palpebral 3. The lacrimal
• In addition, the upper lid also
contains levator palpebrae
superioris muscle(LPS).
It arises from apex of the orbit and is
inserted by three parts on the skin
of lid, anterior surface of tarsal plate
and conjuctutiva of superior fornix.
It raises the upper lid. It is supplied
by a branch of occulomotor nerve.
 STRUCTURE ANTERIOR POSTERIOR

• 4. Submuscular areolar tissue: The layer of loose

connective tissue. • The nerve and vessels lie in
this layer. • Therefore, to anaesthetize lid,
injection is given in this plane.
• 5.FIBROUS LAYER:- It is the framework of the lids
and consist of two parts: the central tarsal plate
and the peripheral septum orbitale.
a.) Tarsal plate: There are two plates of dense
connective tissue, one for each lid, which give
shape and firmness to the lids. The upper and
lower tarsal plates join with each other at medial
and lateral canthi; and are attached to the orbital
margins through medial and lateral palperable
ligaments. In the substance of the tarsal plates
lie meibomian glands in parallel rows.
b.) Septum orbitale (palpebral fascia). It is thin
membrane of connective tissue perforated by
nerves , vessels and LPS muscle, which enter the
lids from the orbit.
 6. Conjunctiva
Anatomically, it is divided into the following:
The palpebral conjunctiva starts at the
mucocutaneous junction of the lid margins
and is firmly attached to the posterior tarsal
plates. The tarsal blood vessels are vertically
orientated.
The forniceal conjunctiva is loose and
redundant.
The bulbar conjunctiva covers the anterior
sclera and is continuous with the corneal
epithelium at the limbus. Radial ridges at the
limbus form the palisades of Vogt, the likely
reservoir of corneal stem cells. The stroma is
loosely attached to the underlying Tenon
capsule, except at the limbus, where the two
layers fuse. The plica semilunaris (semilunar
fold) is present nasally, medial to which lies a
fleshy nodule (caruncle) consisting of
modified cutaneous tissue.
 Conjunctiva
• The conjunctiva is a transparent mucous membrane that lines
theinner surface of the eyelids and the anterior surface of the
globe, terminating at the corneoscleral limbus. It is richly
vascular, supplied by the anterior ciliary and palpebral
arteries. There is a dense lymphatic network, with drainage to
the preauricular and submandibular nodes corresponding to
that of the eyelids. It has a key protective role, mediating both
passive and active immunity.

.
Meibomian glands: present in stroma of tarsal plate
arranged vertically. About 30-40 in upper & 20-3- in lower
lid. They are modified sebaceous glands & their ducts
open at lid margin.
• Glands of zeis: These are also sebaceous glands which
open into the follicles of eyelashes.
• Accessory lacrimal glands of Wolfring: These are present
near the upper border of tarsal plate.
• Glands of Moll: Modified sweat gland situated near the
hair follicles or into the duct’s of Zeis glands. They do not
open directly into the skin surface as elsewhere. 
Lacrimal system
The lacrimal apparatus comprises the structures concerned
with formation of tears i.e the main lacrimal gland and
accessory lacrimal glands and its transport

Components of lacrimal apparatus

1. Secretory lacrimal apparatus:
• Main lacrimal gland
• Accessory lacrimal gland: glands of Krause & glands of
wolfring.
2. Excretory lacrimal apparatus:
 Lacrimal puncta
 Lacrimal cannaliculi
 Lacrimal sac
 Naso lacrimal duct
 Main lacrimal gland
• SITE- in lacrimal fossa formed
by orbital plate of frontal
bone in the anterolateral
roof of orbit SHAPE-almond
shaped TYPE-exocrine
PART-superior orbital and
inferior palpebral part
Separated by lateral horn of
aponeurosis of levator
muscle.
 ACCESSORY LACRIMAL GLANDS

Same structure as main lacrimal

gland Very small in size
• Glands of Krause: Upper lid-40-
42 , Lower lid-6-8 , Deeply
situated in the conjunctiva near
the fornix on lateral side
• Glands of Wolfring: Few in
number Situated near the
upper border of the tarsal plate
Rudimentary accessory lacrimal
glands: Present in the
caruncle,plica semilunaris and
infraorbital region.
 LACRIMAL DUCTS

• 10-12 lacrimal ducts -2-5from orbital portion 6-8 from

palpebral portion
• The ducts from the orbital portion joins with the
palpebral portion & finally open into the superior
fornix approx.5mm above the lateral tarsus border
Clinical importance: Removal or damage even only to
the palpebral portion of the gland amounts to the
excision of the entire gland as far as secretory
function is concerned .
 lacrimal punctum
• Small rounded or oval opening. In
upper and lower eyelid at junction of
ciliary and lacrimal portion of lid
margin Upper-6mm and lower 6.5mm
later to inner canthus On closure of
eyelid punctum do not overlap.
• Each punctum sits on top of an
elevated mound known as the papilla
lacrimalis. They are relatively
avascular in comparison to the
surrounding tissue, giving them a pale
appearance, which is accentuated
with lateral traction of the lid. 
 Lacrimal canaliculi
• LENGTH-Each are 8-12mm long LENGTHCOURSE-
2mm vertical&8-10mm horizontal. UNION-90%
they unite as a common canaliculus and in about
10% opens separately in lateral wall of the orbital
sac. VALVE-Valve of Rosenmuller,a mucosal fold
overhangs the junction between common
canaliculi and prevents reflux. 28/77
• ANGLE- between the vertical and horizontal
segments is approximately 90 degrees, and the
canaliculi dilate at the junction to form the
ampulla.. LININGS-by nonkeratinized stratified
squamous epithelium and are surrounded by
elastic tissue, which permits dilation to 2 or 3
times the normal diameter. CLINICAL
SIGNIFICANCE An incompetent valve of
rosenmullar is observe clinically as air escaping
From the lacrimal puncta when the indivisual
blows his or her nose 
 LACRIMAL SAC

• Site lacrimal fossa: (anterior part of medial

orbital part) where sac is encovered by
lacrimal fasica (periorbita i.e periosteum
lining of orbit)
• Length: 15mm Volume : 20cc Parts :fundus
(3-5mm) , body (10-12mm) & neck Lining of
double layer epithelium (upper is columnar
and deeper is falter)

•  Relations Medial to sac separated by

periorbita and bone lie – anterior ethmoidal
sinuses Below it lies: nasal middle meatus
Lateral to it lies skin ,part of orbicularis oculi,
lacrimal fascia Anteriorly lies the medial
palpebral ligament & angular vein Posterior
to sac lies lacrimal fasica & septum orbitale 
 Nasolacrimal duct
• Length-18 mm  Diameter-
3mm
Upper end- narrowest 
Direction- downwards,
backward & laterally Parts-
Intraosseous part 12.5mm &
Intrameatal 5.5mm
Lower end- opens into the
nose through an ostium
under the inferior turbinate,
covered by valve of Hasner
 Optic Nerve
• Second cranial nerve - Starts from
optic disc, extends up to optic chiasm
• Backwards continuation of nerve fiber
layer of retina( axons of ganglion cells)
• Also contains afferent fibers of light
reflex and some centrifugal fibers
• Comparable to sensory tract (white
mater) of brain because: Optic nerve
is an outgrowth of brain, Not covered
by neurilemma( doesn’t regenerate).
Surrounded by meninges unlike other
peripheral nerves.
Both primary and sensory neurons are
in retina.
 Optic nerve
• Afferent fibres. The optic nerve carries approximately 1.2 million afferent nerve fibres,
each of which originates in a retinal ganglion cell. Most of these synapse in the lateral
geniculate body, although some reach other centres, notably the pretectal nuclei in the
midbrain. Nearly one-third of the fibres subserve the central 5° of the visual field. Within
the bundles by fibrous septae derived from the pia mater.
• Surrounding layers - innermost layer is the delicate and vascular pia
mater. The outer sheath comprises the arachnoid mater and the tougher dura mater which is
continuous with the sclera; optic nerve fenestration involves incision of this outer sheath.
The subarachnoid space is continuous with the cerebral subarachnoid space and contains
CSF.

The optic nerve is approximately 50 mm long from globe to chiasm. It can be subdivided into
four segments:

• 1.intraocular-1mm.
• 2.intraorbital-30mm.
• 3.intracanalicular-6-9mm.
• 4.intracranial-10mm